Pat Breen (Clare, Fine Gael)

At the outset, I should like to acknowledge the presence in the Visitors Gallery of a group of students from LIT in Limerick, led by their teacher, Ms Martina Neylon. They are all very welcome.

I welcome the opportunity to contribute to the debate this afternoon because for far too long nurses and midwives have been playing second fiddle to other health care professionals. At the end of last year, as Deputy Aylward has said, there were 89,545 registered with An Bord Altranais and it is a profession that was predominately embraced by women. In fact 82,545 of the nurses registered in the country last year were female, and women outnumbered men who chose to study nursing by a ratio of 10:1. Be the end of last year there more than 7,000 registered male nurses in the country. That is one for the Minister of State, and she might acknowledge that we are getting there.

Nurses from all over the world are among the pillars of our society, as previous speakers have indicated. It is only right that their profession should receive the recognition it deserves. Dag Hammarskjöld once said, "Constant attention by a good nurse may be just as important as a major operation by a surgeon". How true it is. Anyone who has had to spend any length of time in a hospital appreciates the work of a nurse. It is a caring profession and many nurses are drawn to it because they want to make a real difference and want to care and help people.

The role of a nurse in our society for long periods was very much under valued; possibly because it was a profession which was significantly dominated by women. It is now finally being recognised as a profession and I welcome that. Nurses in our hospitals are working under very difficult circumstances; budgetary constraints and the policy of reconfiguration without having the additional resources in place when services are being transferred, which has caused real problems. Take the mid-west region for example and my constituency of Clare. When the Minister and the HSE made the decision to transfer services from Ennis General Hospital in favour of the Mid West Regional Hospital in Limerick, it is the patients and the nurses who have to endure the pain, because the cart was put before the horse. The additional resources were not put in place in Limerick to cope with the influx of additional patients from both Nenagh and Limerick. The situation at the emergency department in Limerick can best be described as chaotic at times and this overcrowding led to an industrial dispute at the Hospital late last year nurses were forced on to the streets to highlight the situation.

I have received numerous complaints about the situation in Limerick from Clare patients. One family was very upset during the year when their mother who has a heart complaint was left sitting on a trolley for over 24 hours before she got a bed. Is it any wonder then that nurses who have to work in these conditions feel undervalued?

It is the same story at Ennis General Hospital where the restrictions on budgets, the transfer of services; the embargo on recruitment has left nurses enormously concerned for their future. Morale is low as nurses are very much undervalued in a system which is geared more towards saving euro, when it should be geared to providing and developing the services it provides to its patients.

There are major opportunities for nurses to develop at Ennis General Hospital if the infrastructure and services are delivered to the hospital. Ennis hospital was led to believe that it would be the right arm of Limerick Regional Hospital when reconfiguration came in, but sadly it is being left behind. Nurses at Ennis General Hospital in fact have been shortchanged by the promises made by the HSE and the Minister when the reconfiguration was mooted. The CT scanner at the hospital was no sooner in operation that the plug was pulled. I understand that a permanent radiologist has been appointment, but this position could again be under threat, since the consultant might be based at Limerick instead of Ennis. I ask the HSE to clarify that situation. The fact that the Hospital is only providing a limited CT service, does not encourage GPs to send on their patients to Ennis and as a result private patients are attending elsewhere to have their scans done.

As a result, private patients are going to other hospitals where the scans can be done. If nurses are to have confidence that they can develop their careers in hospitals such as Ennis, it is essential that services are developed in this hospital, where there is a clear demand for them, and that funding be made available for and invested in developing those services.

The endoscopy unit at the hospital is not yet in place, and there are no dedicated geriatric beds, although these were promised. Funding is also required to ensure the surgical department has adequate facilities available to encourage greater utilisation by consultants. Ennis General Hospital is well capable of delivering a top-class service with high patient safety focus. However, proper investment is required if reconfiguration is to be achieved in a timely fashion.

Clare people feel that when it comes to health services, they are at the bottom of the pile. When the mammography unit at Ennis General Hospital was decommissioned in 2007, Clare patients were promised they would be accommodated at the centre of excellence which was being set up in Limerick. In March 2008, Limerick Regional Hospital advised that it was only accepting symptomatic cases. In April 2009, the National Cancer Screening Service took the unusual step of issuing a press release indicating that the roll-out of the service to Clare would face further delays because of the Government's ban on recruitment. The Government assured us this was not the case and that the roll-out would go ahead as scheduled in June.

This week, however, further controversy erupted in an Adjournment debate taken by the Minister of State, Deputy Áine Brady, earlier this week. In reply to a Clare Deputy, the Minister of State claimed that when BreastCheck was seeking an appropriate site for a mobile unit, Clare County Council had delayed the project. The county council denies this. Perhaps the Minister will clarify this at some stage in her contribution, as it is an important issue for the women of Clare. We do not want to hear one authority or body blaming another. Who was delaying the project? The service will be up and running by next October, but a war of words is not in the best interests of the women of Clare, who are still waiting for this essential service. The roll-out must go ahead as scheduled without any further delays.

This country, like many others, has moved away from hospital-based schools or colleges of nursing to courses based in third level institutions. Ireland is probably unique in that all nursing courses are at degree level and professional registration is only available through a degree-level qualification. The fact that nursing programmes are now based in our third level colleges has helped engender a greater respect for those entering nursing as a career. Sadly, however, like many other young people, qualified nurses are leaving the country in droves. Fresh from graduation, Irish nurses are being swept off their feet with offers of employment in the UK. While researching my contribution this afternoon I found that every one of the new recruits at the Royal Berkshire Hospital last December was Irish and that the management of UK hospitals are delighted with the influx of Irish graduates. They say that Irish nurses are well trained and flexible; they speak English, naturally; and they are highly educated university graduates. In addition, Whipps Cross hospital in East London recruited 132 nurses from Ireland last year. These statistics speak volumes.

According to the INO, none of the 1,600 nurses who qualified in this country last year was offered a post in the Irish health system, and some 1,900 nursing and midwifery posts have already been lost as a result of the moratorium on staffing. Nurses have been leaving the country for many generations by choice, but now they are leaving because there are no jobs for them here. In 1945 and 1946, more than 7,000 Irish women applied to train as nurses in the UK, and by 1971, one in eight nurses working for the NHS was Irish. It appears we are heading backwards and educating another generation of nurses for emigration. That is a great pity, given the focus on the nursing profession in Ireland.

This drive across the Irish Sea is not helped by the embargo on public service recruitment in this country. We must consider seriously what is happening in our health services. If good health care professionals who are highly qualified continue to be driven out of this country, what kind of health service will we be left with?

The Nurses and Midwives Bill 2010 promises that programmes of education and further education will be provided to nurses for the purpose of registration. In its submission to the Minister for Health and Children on the proposed heads of the Bill, the Irish Association of Directors of Nursing and Midwifery warned that "funding must be provided and ring-fenced for continuing professional development". It also warned that "Resources, time, finance and opportunity [for] education and training must be protected by the Act." While welcoming the fact that legislation is being introduced which will underpin the role of nurses and midwives, it warned that the necessary infrastructure for nurse and midwife undergraduate and postgraduate education which is in place must be maintained.

The report from the Commission on Nursing published in 1998 also warned that there is a need for a long-term financial commitment for staff development programmes. However, given the fact that most nurses are now under major pressure as a result of the recruitment ban, when will nurses be able to attend these development courses, and will they be penalised if they are unable to attend because of the pressure of their work? This is something that must be considered. Will the majority of development courses involve on-the-job training? This is an important point which needs to be clarified by the Minister.

With regard to the registration system which will now apply, I understand it will be funded by fees collected from registered nurses and midwives. Currently, nurses pay an initial fee of €145 when they first register and an annual retention fee of €85. It is estimated that it will cost €3 million euros to set up this new board. The transfer of certain regulatory functions from the National Council for the Professional Development of Nursing and Midwifery will result in a €25 increase in the annual retention fee, and a once-off fee of €34 will also need to be paid for the establishment of a competency scheme. Some argue that the registration fee is lower than the fee charged by the Medical Council, which is €490; however, the high fee charged by the Medical Council is accounted for by the fact that there are far fewer medical practitioners registered here.

Perhaps the Minister could also explain why the mental health, intellectual disability, children's and public heath nursing sectors are not being put on a statutory basis. Furthermore, clarification is required with regard to nurses and midwives who are pursuing education and training which will ultimately lead to first-time registration with the new board. Why do undergraduates need to register with this new board and pay a fee? I would like to hear the reasoning behind this from the Minister.

Will the Minister also clarify the position with regard to nurses and midwifes who have taken time out from their career for one reason or another and who are not registered for that period? What conditions will these nurses and midwifes be required to fulfil when they return to the profession and will these involve additional costs? What is the situation regarding the registration of international nurses who come to work here, particularly international students who take up clinical placements in our hospitals? Are these students to be treated the same way as our undergraduates, for example, or will there be a separate section to cater for rostered international students?

On the issue of the funding and setting up of the new structure, I never cease to be amazed by the number of jobs created on boards by the Government to dole out to its political friends. We have seen many such examples over the years. The new board proposed here will comprise 23 members, both elected and appointed members. Unlike the composition of the previous boards, the majority of members will not be nurses or midwives. Instead, only eight members of the board will represent that sector and only one midwife will sit on it. This is completely inadequate, particularly given the fact that in 2008, for example, we saw the highest number of births recorded in Ireland since 1896, with a total of over 75,000 births recorded. There is no way that the work of midwives will be adequately represented by just having one member on the board. I urge the Minister to clarify this situation.

Section 25 allows for payment of allowances to members of the board or committee. Who will receive these allowances? Are they for the political appointees and what is the maximum amount each member will be able to claim? What criteria are being applied by the Minister for those non-nursing representatives who will sit on the board? In respect of appointments to boards, it is surely time that proposals for appointees to State boards should come before the relevant Dáil Committee to be scrutinised. Perhaps the Minister should clarify what qualifying criteria will be applied in respect of these appointments and whether she supports the notion of appointees coming before the Dáil health committee.

There is huge potential for development in the area of care of the elderly and nurses have an important role to play in this regard. Ennis General Hospital was promised dedicated geriatric beds following reconfiguration, but once again the Minister and the HSE failed to live up to their promises to the people of County Clare. The Commission on Nursing recommended that the Department of Health and Children should examine "as a matter of urgency the conditions and staffing levels in care of the elderly services". The report was published in 1998, but as we all know from the calls we get daily in our offices, home help hours have been cut. We were promised that we would have a more integrated approach to primary care and that home care packages would be available and adapted to meet the patients' needs. However, the experience is very much the opposite and people cannot access the help they need. Every day I receive pleas for help from older people and their families.

The Bill also provides for the resolution of complaints through mediation and other formal means. It establishes a competency scheme to monitor the competence of all nurses and midwives, deals with fitness to practice and proposes the dissolution of the National Council for the Professional Development of Nursing and Midwifery and the transfer of its staff, assets and liabilities to the board. While I welcome the recognition the Bill gives to nurses and midwifes, it is very important that adequate consideration is given to all these issues and that they are debated fully here in the House.

I am very interested to hear from the Minister with regard to the consultation process she undertook before she brought the Bill before the House. Perhaps she will outline some of the issues which were raised. I am pleased to have had this opportunity to speak on the Bill and look forward to the Minister's response.

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